Provider Demographics
NPI:1437282316
Name:PROHEALTH PARTNERS, A MEDICAL GROUP
Entity Type:Organization
Organization Name:PROHEALTH PARTNERS, A MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALLSWANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-299-5200
Mailing Address - Street 1:1045 ATLANTIC AVE
Mailing Address - Street 2:SUITE 705
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 E SAN ANTONIO DR
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2211
Practice Address - Country:US
Practice Address - Phone:562-422-3338
Practice Address - Fax:562-422-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0064154Medicaid
CAZZZ60546ZOtherBLUE SHIELD GROUP NUMBER
CAW13421HMedicare PIN